Sheffield Local Optometric Committee

Sheffield LOC Meeting Monday 11th April

SLOC Minutes of the Meeting

Held: Monday 11th April 2011

Present: Phil Banton (PB), Shirley Blundell (SB), Helen Bailey (HB), Gerry Cowley (GC), Rob Hughes (RH – Chair), Tanveer Hussain (TH), David Inman (DI), Sue Wilford (SW), Helen Wilkinson (HW)

Guest: Ian Atkinson (IA) – Interim Chief Executive – NHS Sheffield, Alastair Mew (AM)

Attendees: Louise Lambert (LL) (Minutes)

Apologies: Mike Daybell (MD), Steven Haigh (SH), Azad Nawaz (AN), Richard Oliver (RO), Habib Shah (HS),

Minutes of the last meeting
The minutes of the last meeting held on Monday 11th April 2011 were accepted as a correct record. Proposed by RH and seconded by HB

Ian Atkinson – Transition details
RH opened the meeting and welcomed IA – IA introduced himself to the group explaining due to his previous role, as Director of Performance, he was aware of the various schemes that LOC assisted with, including the Contact Applanation Tonometry Service (CATS).

IA proposed to give an overview of the NHS reforms and how it relates to Sheffield. As part of “Liberating the NHS”, all foundation trusts have to undergo huge structural changes. Part of the Governments vision is to reduce the bureaucracy and allow Clinicians, the leadership of achieving the necessary £20 billion of efficiency savings to the NHS. Establishing how those saving can be accomplished.

The coalition health policy has degrees of strength, however there are fault lines along the coalition’s proposed agenda cuts. There is a management deficit requiring drastic action. Processes are standing still during the listening exercise and the coalition could sustain damage. Clinicians are having concerns regarding the future, how it is currently described.

The listening exercise is the national picture and how that relates to Sheffield is fundamental to the Primary Care Trust (PCT) and the Strategic Health Authority (SHA) being phased out. Nationally 150 PCT’s are clustering into 50 clusters. The PCTs, which make up South Yorkshire and Bassetlaw cluster are Barnsley, Bassetlaw, Doncaster, Rotherham and Sheffield. Nationally clusters are developing, interestingly South Yorkshire and Bassetlaw (SYB) Cluster is developing differently. Elsewhere clusters are assuming the heads of boards. Within SYB each PCT will retain its non-executive directors and relevant board, this arrangement will allow the continuation of many of the excellent partnership arrangements with providers, such as SLOC.

Over the next two year there is a need to obtain a 2 million pound staff saving and Sheffield have now started to look at Voluntary redundancies, while also looking at other ways of saving possible including compulsory redundancies. The idea behind the cluster is the continuation of business and sustaining the loss of staff.

Sheffield has four GP consortia who have established the General Practitioner Commissioning Consortia (GPCC). Details of their work together are still being clarified, it is thought that three of the consortia will work together and one individually.

The GP Commissioning Consortia Committee (GPCC C) will be an interim management agreement which will replace the PCTs board. Supported by the SYB cluster the GPCC C will delegate duties and responsibilities to the “Chief Operating Officer” – IA new role (what was the Interim Chief Executive).

It is thought that the listening exercise will clarify who of the selected individuals to sit on the board. It was thought wider then clinician experience was required potentially including individuals from local council and secondary care commissioners. There is still a degree of uncertainty as to who will be part of the GPCC C.

In the short-term Sheffield locally will form functions by the middle of the year. By early 2012 funding for the GPCC is hoped to be available and the GPCC will start operating as support organisation.

The core principals sound fine, however the logistics and political issues are intertwined. Once the clusters have been removed, clarification is required on how the GPCC C will manage services. The feasibility on whether the GPCC C can commission a billion pound of services was questioned. This prompted the group to discuss further the balance between skills, clinicians and competent managers, the group further speculated on services.

RH thanked IA for his time and informing the committee of the current position with NHS Sheffield, on behalf of the group he also extended an open invitation, which IA kindly accepted and proposed to give a 15 minute update, half way through the “listening exercise” at the meeting scheduled to take place on Tuesday 16th August 2011

IA offered to address any further questions the group had. RH said it was reassuring, from the LOC position, that the four consortia where taking a joint citywide approach. IA reflected that GPC have been very clear with its proposed approach, staying with one contract across the city. IA suggested that members of the GPCC C could be either selected or elected and potentially involving wider expertise in the form of councillors bringing different depths and benefits to the GPCC C

Matters Arising

1. Paediatric Referral Refinement (PRR)

The PRR pathway has had some initial “teething” problems. SCH have not been flagging up children unreported after 6 weeks. IT systems are now in place to assist this.

There has been a lack of reporting by some optometrist however it also become clear that the SCH fax used to receive reports had been broken for a time.

There has been a positive response from the reminder email, about returning report forms, however optometrist may still need to be chased for previous report forms.

In relation to SPA (replacement for RIS) the group would like the PCT to confirm who has now taken responsibility for queries for PRR scheme and clarify what information they were receiving and reporting on. It was proposed to include the response within the Service Level Agreement (SLA) and on the LOC website.
Action: AM to clarify and feedback

The group had a brief discussion about the need to offer patients “choice” and the options available, concluding to offer “choice” to the parent, at the point of referral. If parents/guardian chose another provider, other than Sheffield Children’s Hospital, optometrists are still required to send the report to Children’s.

The group discussed direct onward referral from the PRR scheme to secondary care and wanted to confirm potential processes with the PCT. SB to issue AM processes for confirmation.
Action: AM to confirm with Linda Lydament (LLy)

Referrals, with patient identifiable information, should only to be sent via NHS mail. It was then questioned whether Children’s have a NHS mail and this was confirmed by SB. The benefits of a single form was discussed and a proposed outline is to be emailed to LLy
Action: Email proposed form outline to LLy
Action: Can LLy confirm which optometrists have NHS email addresses
Action: AM to discuss running along the same principals with Phil Kitchen (PK)

The grouped discussed an individual case where the patient failed screening after wearing new glasses for only 10 days. The group considered it to be good practice for the screening orthoptist called the optometrist when such issues arise. The group also discussed other scenarios

The protocol of the scheme relies on courtesy between fellow professionals. A meeting where all participates can discuss protocol was considered to be beneficial
Action: SB to arrange meeting between all parities

2. Primary Eyecare Acute Referral Scheme (PEARS)

AM feedback between April 2010 and February 2011, it was estimated that the scheme has saved £85,000, taking out ‘non-PEARS’ conditions and glaucoma related referrals the saving were £35500.

RH shared with the group how he manages PEARS, and how he reports back to the referring optometrists.

AM informed the group that LLy does have list of which practices are participating with each scheme.
Action: SW to issue protocols to each practice on memory stick
Action: AM to provide practice scheme list

To enable the triaging optometrists to refer patients to the most appropriate setting (PEARS or secondary care) it was suggested writing to all optometrists to request that, as much detail is included in the glaucoma referrals as possible. It was thought that the letter should be signed by Richard Oliver
Action: PB to draft and send for approval

The group reviewed various schemes, commenting that PEARS and PRR, in conjunction with electronic reporting, like CATS, would be beneficial. They also queried if optometrist and PCT would be able to review the reporting facility, with the ability to analyse fee distribution.

From the 1st July 2011 it was hoped that PEARS would be electronic reporting. AM suggested holding back PRR from electronic reporting until all parties were confident in its structure and protocols. He expressed the benefits of schemes running with the same principals.

The group discussed the various different signs of glaucoma that can be mentioned on a GOS18 along with which of these signs or combination of signs should be referred to PEARS and which to secondary care. It was thought worthy of getting triaging optometrists together to discuss a range of scenarios, in the mean time sending out a letter / email to inform them of those variations and outcomes.

3. Contact Applanation Tonometry Service (CATS)

CATS is progressing well, AM agreed that online processing was extremely useful. SB is now able to access systems online.

187 patients have been seen under the scheme, none referred onto Secondary Care. The group highlighted to AM a potential error within the reporting system.
Action: HB to issue patient identified to AM to review
Action: Lly to liaise with Phil Kitchen, and check the reporting system to clarify how far it can report back.


No correspondence was received

Any other business

The group discussed the annual meal and provisionally suggested the Beauchief Hotel on Tuesday 17th May 2011

DI has not currently arranged any practice visits on behalf of LOC, he was waiting until after the transitional period and until there was no further amendments to the schemes. It was decided that DI would start practice visits, keeping it general and obtaining interest levels. Accreditation for PEARS could not be offered, due to PCT funding, however the practice could register interest. There would have to be a minimum of 6 optometrists to make the training cost effective. For PRR and CATS practices would just have to sign and agree to protocols.
Action: AM to discuss with LLy the PEARS coverage across the city

It was suggested as SLOC were already writing to optometrists, it would be worth including the proposed practice visits and for the practices to contact DI directly. Action: DI to feedback to group response

The group agreed the importance of keeping the website up to date, during this transitional period.

Date of next meeting

Tuesday 24th May 2011 at 19:30hrs, Beauchief Hotel, Abbeydale Road

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